HomeMy WebLinkAboutWell New 153 Clark Street CPR-8 Rev.7195 PERMIT NUMBER
STATE OF CONNECTICUT j Lam,�j .1- 17 7 O 7
DEPARTMENT OF CONSUMER PROTECTION. . �(J
REAL ESTATE&PROFESSIONAL TRADES DIVIS N
WELL DRILLING PERMIT OCT _i 197A® ,
I6 apitol Avenue,Hartford, cti t 06 �
-CC(IPA -1 r•, .
LOCATION OF WELL (Town) (Street) (Lot Number) Lei of Con
a UlYIZjIUN
2
�m .ro �lltS
OWNER OF WELL '
(DUAL ff-9 ILDER OTHER(Specify)
OWNER'S ADDRESS
Est.No.of
PROPOSED ESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC.11SUPPLY ElINDUSTRIAL AIR CONDITIONING OTHER
SKETCH OF WELL LOCATION
Locate'well with respect to at least two roads,showing distance from intersection and front of lot
location of lot to at least two roads Well location on to and to house(if present)
Indicate North
ZC-3 Zj=d--dJV-
U
Approximate number of feet from well to
nearest source of possible contamination:
The undersigned is aware that upon completion of the well,a'Well Completion Report"containing construction details and information required under
Section 25-131 of the 1969 Supplement to the General Statutes must be sent to the owner,the Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by,
rector of Health or his agent.
P CANT nature) APPLICANTS ADD REGISTRATION NO.
ROVED VEXED
own H flh 011icerorAgent) DATE
A ❑
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7195
STATE.OF CONNECTICUT STATE WELL NO.
t DEPARTMENT OF CONSUMER PROTECTION
x REAL ESTATE&PROFESSIONAL TRADES DMSION OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hardord,Connecticut 06106
OWNER NAME ADDRESS
STAN NADOLNY 153 9XXR CLOCK ST SOUTH WINDSOR, CT
LOCATION (No.a Street) (Towne) (Lct Number)
OF WELL 153 CLOCK ST SOUTH W I NDSOR 153
DOMESTIC BUSINESS FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL ,a PUBLIC ❑ INDUSTRIAL AIR OTHER
SUPPLY CONDITIONING S
DRILLING a ROTARY �X AIR PERCUSSION CABLE OTHER
(Specify)
EQUIPMENT � '
CASING LENGTH(feet) DIAMETER(ndies) WEIGHT PER FOOT DRNE SHOE WAS CASING GROUTED?
DETAILS 40 6 1 7# 12 THREADED a WELDED � YES ❑ NO U YES ❑ NO
YIELD TEST a BAILED PUMPED Q COMPRESSED AIR HOURS YIELD(GPM)
4 30
WATER MEASURE FROM LAND SURFACE-STATIC(Spe-0 feet) OURING YIELD TEST(feet) Depth of Completed Wei in feet
LEVEL 20 225 225
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(ndbs) IF GRAVEL Diameter of well I GRAVEL SIZE(nd,ea) FROM(feet) TO(feet)
PACKED: ndudng gravel peck
- (uedees)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distarIces,tt at(east two
"FEET TO FEET permanent landmarks
0 • 15 Sand & Gravel
15 35 Hard Porn & Safe'Y a ge
35 225 Red Shale
foi 50 l04
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE Q
-- -- V
DATE WELL COMPLETED PERMIT NO. REGISTRATION td0. DATE OF REPORT WELL GRILLER(S' )
9/25/96 177707 102 '/D P
AGENCY
MDC
The Metropolitan District
water supply•environmental services•geographic information
iii]Fri,
REPORT OF LABORATORY EXAMINATION
REPORTED 12/9/96
SPECIMEN 741,726
SOURCE Cindy Naldonv-Well isa d�Lw
COLLECTED 12/6/96
FOR DETERMINATION OF BACTERIA AND ROUTINE PHYSICAL
SHOWED THE FOLLOWING
Coliforms per 100 ml 0
20' C. Plate Count 0
Standard Plate Count 270
Color 5
pH 7.5
Turbidity 2.61 ntu
Odor 0
Chlorine(residual) Not Applicable
Conductivity 472
Hardness 184
St h n Pratt
La oratory Administrator,
MDC
555 Main Street Post Office Box 800 Hartford,Connecticut 06142-0800 telephone:860-278-7850 fax:860-724-2679